Efficacy of the stand-alone Cox-Maze IV procedure in patients with longstanding persistent atrial fibrillation
© 2021 Wiley Periodicals LLC..
INTRODUCTION: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and results in significant morbidity and mortality. The Cox-Maze IV procedure (CMP-IV) has been shown to have excellent efficacy in returning patients to sinus rhythm, but there have been few reports of late follow-up in sizable cohorts of patients with longstanding persistent AF, the most difficult type of AF to treat.
METHODS AND RESULTS: Between May 2003 and March 2020, 174 consecutive patients underwent a stand-alone CMP-IV for longstanding persistent AF. Rhythm outcome was assessed postoperatively for up to 10 years, primarily via prolonged monitoring (Holter monitor, pacemaker interrogation, or implantable loop recorder). Fine-Gray regression was used to investigate factors associated with atrial tachyarrhythmia (ATA) recurrence, with death as a competing risk. Median duration of preoperative AF was 7.8 years (interquartile range: 4.0-12.0 years), with 71% (124/174) having failed at least one prior catheter-based ablation. There were no 30-day mortalities. Freedom from ATAs was 94% (120/128), 83% (53/64), and 88% (35/40) at 1, 5, and 7 years, respectively. On regression analysis, preoperative AF duration and early postoperative ATAs were associated with late ATAs recurrence.
CONCLUSION: Despite the majority of patients having a long-duration of preoperative AF and having failed at least one catheter-based ablation, the stand-alone CMP-IV had excellent late efficacy in patients with longstanding persistent AF, with low morbidity and no mortality. We recommend consideration of stand-alone CMP-IV for patients with longstanding persistent AF who have failed or are poor candidates for catheter ablation.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2021 |
|---|---|
| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:32 |
|---|---|
| Enthalten in: |
Journal of cardiovascular electrophysiology - 32(2021), 10 vom: 26. Okt., Seite 2884-2894 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
McGilvray, Martha M O [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Atrial fibrillation |
|---|
| Anmerkungen: |
Date Completed 20.10.2021 Date Revised 27.10.2021 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1111/jce.15113 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM325906882 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM325906882 | ||
| 003 | DE-627 | ||
| 005 | 20231225193435.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2021 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1111/jce.15113 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1086.xml |
| 035 | |a (DE-627)NLM325906882 | ||
| 035 | |a (NLM)34041815 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a McGilvray, Martha M O |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Efficacy of the stand-alone Cox-Maze IV procedure in patients with longstanding persistent atrial fibrillation |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 20.10.2021 | ||
| 500 | |a Date Revised 27.10.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021 Wiley Periodicals LLC. | ||
| 520 | |a INTRODUCTION: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and results in significant morbidity and mortality. The Cox-Maze IV procedure (CMP-IV) has been shown to have excellent efficacy in returning patients to sinus rhythm, but there have been few reports of late follow-up in sizable cohorts of patients with longstanding persistent AF, the most difficult type of AF to treat | ||
| 520 | |a METHODS AND RESULTS: Between May 2003 and March 2020, 174 consecutive patients underwent a stand-alone CMP-IV for longstanding persistent AF. Rhythm outcome was assessed postoperatively for up to 10 years, primarily via prolonged monitoring (Holter monitor, pacemaker interrogation, or implantable loop recorder). Fine-Gray regression was used to investigate factors associated with atrial tachyarrhythmia (ATA) recurrence, with death as a competing risk. Median duration of preoperative AF was 7.8 years (interquartile range: 4.0-12.0 years), with 71% (124/174) having failed at least one prior catheter-based ablation. There were no 30-day mortalities. Freedom from ATAs was 94% (120/128), 83% (53/64), and 88% (35/40) at 1, 5, and 7 years, respectively. On regression analysis, preoperative AF duration and early postoperative ATAs were associated with late ATAs recurrence | ||
| 520 | |a CONCLUSION: Despite the majority of patients having a long-duration of preoperative AF and having failed at least one catheter-based ablation, the stand-alone CMP-IV had excellent late efficacy in patients with longstanding persistent AF, with low morbidity and no mortality. We recommend consideration of stand-alone CMP-IV for patients with longstanding persistent AF who have failed or are poor candidates for catheter ablation | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Cox-Maze IV | |
| 650 | 4 | |a atrial fibrillation | |
| 650 | 4 | |a late outcomes | |
| 650 | 4 | |a longstanding persistent atrial fibrillation | |
| 650 | 4 | |a surgical ablation | |
| 700 | 1 | |a Bakir, Nadia H |e verfasserin |4 aut | |
| 700 | 1 | |a Kelly, Meghan O |e verfasserin |4 aut | |
| 700 | 1 | |a Perez, Samuel C |e verfasserin |4 aut | |
| 700 | 1 | |a Sinn, Laurie A |e verfasserin |4 aut | |
| 700 | 1 | |a Schuessler, Richard B |e verfasserin |4 aut | |
| 700 | 1 | |a Zemlin, Christian W |e verfasserin |4 aut | |
| 700 | 1 | |a Maniar, Hersh S |e verfasserin |4 aut | |
| 700 | 1 | |a Melby, Spencer J |e verfasserin |4 aut | |
| 700 | 1 | |a Damiano, Ralph J |c Jr |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of cardiovascular electrophysiology |d 1996 |g 32(2021), 10 vom: 26. Okt., Seite 2884-2894 |w (DE-627)NLM074905481 |x 1540-8167 |7 nnns |
| 773 | 1 | 8 | |g volume:32 |g year:2021 |g number:10 |g day:26 |g month:10 |g pages:2884-2894 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1111/jce.15113 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 32 |j 2021 |e 10 |b 26 |c 10 |h 2884-2894 | ||